Student Name
Date Received by Field Dept
Social Work Dept
Application for Field Practicum
Directions: The field education process is a partnership involving the social work program, field education
department staff, social work faculty, field placement sites, field instructors, and social work students.
Your mindful, thorough, completion of this application supports that process and allows us to move
forward in developing a positive field placement. Students who return incomplete or late practicum
applications and/or do not actively collaborate with field education staff will risk delayed entrance into the
field and subsequent delay in completing field requirements.


It is essential that you review the Field Education Manual prior to completing this application.
This will help you to understand the specific requirements of your field placement and the field
education process. The Manual is available on the Social Work Website Field Education Page.
Complete the application electronically.
o Click the appropriate check boxes and/or type information in the expanding text boxes.
o Be sure to save your completed application with your last name as part of the file name (i.e.
“SmithFieldApp.docx”).
o The application is only considered complete when an electronic copy of a current resume is
also provided as a separate document. A current resume should include that your status as a
social work student and any related social work experience (i.e. previous internships,
volunteer experience, etc.).
o Provide an electronic copy of the completed application to your assigned field education
Department staff by the Due Date.
Name
I am applying for: (check one answer)
BSW Field Placement
MSW Foundation Year Placement
MSW Advanced Year Placement in the Traditional MSW Program
MSW Advanced Year Placement in the Advanced Standing MSW Program
I am currently enrolled in:
BSW Program
MSW 2 Year Full-time Program
MSW 3 Year Part-time Program
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MSW 4 Year Part-time Program
MSW Full-time Advanced Standing Program
MSW Part-time Advanced Standing Program
My Contact Information:
1. Best Phone # To Contact Me:
Does this Phone # Change during Semester Break or during the Summer Months?
No
Yes
If yes, please provide the best Phone # to reach you during those times:
2. Email Address: Your Westfield State email address is considered to be your primary email
address, both during the academic year and the summer. You are expected to check this email
regularly as this will be the primary way the field department will communicate with you.
Please do not use personal email addresses during the field education process.
FIELD PLACEMENT INTERESTS AND EXPERIENCE
While meeting your educational needs and program requirements are necessarily the first criteria for field
placement, your preferences are also considered. It is important for you to understand that, while your
preferences will be considered to the extent possible, this does not mean that all your preferences can/will
be met in your field placement assignment.
Client Population/Setting

Are there specific client populations and/or settings (i.e. children, older adults) or practice areas
(i.e. addictions, child welfare, medical facilities, residential services, schools, etc.) you are
particularly interested in? Please discuss your interest (including why these populations interest you
and what, in particular, interests you about these populations) and any previous experience you
have in any of these areas?

Are there specific client populations and/or practice areas you would feel uncomfortable working
with? Please explain here or make an appointment to discuss further with your assigned field
education department staff.
Location of the Placement
Students should expect to complete their field placements in a location that is within no more than
a sixty-mile radius of Westfield State University. Is there a particular geographic location/town
within this radius that you prefer to complete your field placement?
No
Yes, please specify location and reason:
Your Address during the timeframe you will be complete your field placement:
Street
City
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
Transportation
o Do you have a valid driver’s license?
No
Yes
o Will you have access to a car for travel to and from your field placement?
No
Yes
o If you answered “No” to either of the above questions, how will you travel to and from your
field placement?
Your Availability
The Field Education Manual details the specific number of hours required for your field placement.
Generally, placements begin in September and end in early May of the following year, with an overall
requirement of either 400 or 500 hours. It is crucial that you review the sections of the Field Education
Manual that detail the policies related to eligibility for placements, specifically daytime versus
evening/weekend or employment-based placements. Students are expected to do most or all of their
placement hours during regular daytime business hours. While some evening and weekend hours may be
arranged under certain rare circumstances, and may be available to students in the part-time programs, there
are very few placement sites that offer evening and weekend placement hours, especially hours with the
required level of supervision. In addition, all students are required to participate in at least some regularly
scheduled agency staff and clinical meetings, which are generally held during daytime hours, in order to
gain the full experience of working in a social service environment. Most students find it is easier (and
most sites strongly prefer or require) to set aside two or three days with longer timeframes instead of trying
to work only a few hours over several days. Please list your availability (specific hours for each day).
Monday
Tuesday
Wednesday
Thursday
Friday
Sat/Sun
Please explain any other commitments that you believe may affect your availability for your field
placement.
ADDITIONAL INFORMATION

If you have reason to believe that a specific agency/organization is available to you for a field
placement, please provide that information here (including contacts and the reasons(s) you believe
this is available to you) and we will contact the agency/person to discuss field placement
requirements. We always welcome your ideas for new placement possibilities.

Are you considering completing your field placement at your place of employment?
No
Yes
o If, yes, please review the section in the Field Education Manual that discusses this type of
placement. You will need to complete an Application for Employment-Based Field
Practicum (available on the Social Work Website) in addition to this application. Your
application will only be considered complete when both applications are received. As with
all placements, the final approval for an Employment-Based Placement is made by the Field
Education Department.
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
Do you have any particular skills or qualifications that may apply to specific client populations or
practice areas (i.e. fluent in a language other than English, CPR training, licenses, etc)?
No
Yes, please explain

Have you completed previous field placements?
No
Yes.
o If yes, please describe the location of the placement, nature of the placement(s), the aspects
of the placement(s) you felt most useful and any aspects you felt were not helpful.


No
Yes, Please explain.
Most human service organizations are required to perform criminal background (CORI) and/or Sex
Offender Registry checks before accepting students for placement. Protective Service agencies will
check to see if student applicants have histories of involvement with Protective Services. Some
organizations may have additional requirements regarding medical clearances prior to acceptance.
Additionally, students may not be placed in settings where there is a potential or known conflict of
interest and/or dual relationship.
Students are strongly encouraged to discuss any circumstances that may disqualify them for
certain placements with a member of the field education staff so that appropriate placement
assignments may be made and that you are not considered for a placement where you may
ultimately not be accepted. The following information will help us to select appropriate
placements:
o Are there any reasons you could not complete a field placement in a specific agency due to a
conflict of interest and/or potential dual relationship (i.e., have previously worked there
and/or have relatives or friends that work there, you or a family member receive(d) services
there, etc.)? Students with questions about whether or not a specific situation involves a
dual relationship or a conflict of interest should discuss their specific situation with their
assigned field education staff.
No
Yes, Please explain.
o Have you ever been convicted of a crime (misdemeanor and/or felony) and/or have a
negative CORI and/or criminal history in Massachusetts or any other state?
No
Yes
o Are you currently, or have you ever been, a client with the Department of Children and
Families (DCF, formerly the Department of Social Services, DSS) in Massachusetts or any
other state?
No
Yes
o Do you have a documented disability that you expect to make a request for reasonable
accommodations within a field placement?
No
Yes
If, yes, you must contact the Banacos Academic Center on Campus to determine potential
accommodations for that documented disability before the field placement process can
proceed. Written specifics of those potential accommodations must be provided to the Field
Education Staff by Banacos Academic Center prior to your field placement process. It is
very useful to create a collaborative process between the Field Department, the Banacos
Academic Center, and the student, particularly since possible field placement sites will
require clarity of reasonable accommodations that are being requested as part of the
interview process. Also, if appropriate, please provide any information below that you
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believe might be helpful to us in locating the best possible field placement for you.
o Many field settings, particularly medical facilities, require students show proof of
immunizations and a health clearance from a medical professional (the student is
responsible for any associated costs). Do you have any concerns about the potential of
these requirements?
No
Yes
If, yes, please provide additional details here or contact your assigned Field Education Staff
to discuss this further.

All potential field sites request information about a student’s prior work and volunteer experience, a
current resume, status within the social work program (how many years completed, current GPA,
courses taken, previous internships, etc.). While this information is very often crucial to
consideration for an interview, we will only provide this information with your permission. Do we
have your permission to provide this information and/or send a copy of the resume you are
including with this application to a prospective placement representative?
No
Yes
If, no, please contact your assigned Field Education Staff to discuss this further.

Please discuss three social work related skills and strengths you will bring to a field placement.

Please discuss three social work related skills you will need to strengthen during your field
placement.

Please share any additional information, suggestions, or requests that you feel are relevant as we
consider your field placement.
Your electronic signature below confirms the following:

I have read the Field Education Manual and understand that the information contained in the
manual, as well as the information in this field application, represent the policies, procedures, and
guidelines that I am required to follow in regard to the field education portion of my academic
program of study.

My responses in this field application are accurate and complete. I also understand that I am
responsible for contacting the Field Education Department if any of the information changes at any
point in the field education process and/or after I have begun my field placement.
Type Full Name as Electronic Signature
Date Signed
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